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PubMed2006

Case series of four different headache types presenting as tooth pain.

Case reports in the literature discuss various headache disorders that present as pain in the face. The current understanding of neuroanatomy and headache mechanisms suggests that headache pain originates within intracranial structures and is then referred to the face, jaws, and teeth. This case series describes four patients, one each with migraine headache, cluster headache, paroxysmal hemicrania, and hemicrania continua, all of which who presented to dentists with the chief complaint of tooth pain. This is the first report of hemicrania continua presenting as tooth pain. It is important that dentists be cognizant of headache disorders so that they may be able to identify headache pains masquerading as toothache.

Adult↗
PubMedDate not supplied

Chronic daily bilateral headache responsive to indomethacin.

Indomethacin is known to be specifically effective for chronic paroxysmal hemicrania, episodic paroxysmal hemicrania, and hemicrania continua. Different forms of idiopathic stabbing headaches have also been responsive to indomethacin, but less consistently than the others. Two cases of indomethacin-responsive headache are reported. One patient presented with what appeared to be new-onset, chronic, daily, bilateral headache aggravated by coughing. Both the chronic daily headache and the exacerbations induced by coughing were suppressed with indomethacin therapy. The second patient experienced hemicrania continua responsive to indomethacin, and the response persisted even when the headache evolved into bilateral continuous pain. There may be other idiopathic primary headache disorders that are peculiarly responsive to indomethacin. When any primary headache disorder does not respond to standard therapy, a brief therapeutic trial of indomethacin is warranted.

Adult↗
PubMed2005

[History of taxonomy of Headache.]

It takes a long history for human being to understand headache disorder clearly. Fifteen years after its original edition was published, a revised International Classification of Headache Disorder has been unveiled by the International Headache Society (HIS) in 2003, thus, a clear operationalized standard for the headache taxonomy and diagnosis for headache is available. This will galvanize headache community and stimulate the development of headache research. By reviewing the history of headache taxonomy in China and western countries, historical experiences may contribute to make further advances not only in the headache research field, but also in the whole area of medical science.

Journal Article↗
PubMed2003

Adults and children with headache: evidence-based diagnostic evaluation.

Headache represents one of the most common complaints in the outpatient and emergency room setting [1]. Most causes of headache are benign and do not require emergent imaging or intervention. The authors' review of the diagnostic tests does not offer absolute indications for neuroimaging because most of the evidence is based on studies that are not randomized controlled trials. Imaging guidelines for adults and children, however, have emerged based on the available level 2 and 3 literature. CT imaging remains the initial test of choice for new-onset headache in adults and headache suggestive of SAH. Most of the available literature also recommends performing lumbar puncture when CT is equivocal in ruling out SAH [1]. The sensitivity of MR imaging appears to be less than CT for SAH [1]. Newer MR imaging techniques need to be tested and developed to determine if they have higher sensitivity than CT or lumbar puncture in the detection of SAH. In adults with suspected brain metastatic disease, contrast-enhanced MR imaging is the imaging study of choice [38,39]. Contrast-enhanced MR imaging is the examination of choice for brain metastatic lesions less than 2 cm [39]. CT angiography and MR angiography have sensitivities greater than 85% for brain aneurysms larger than 5 mm [43]. If clinically warranted, aneurysms smaller than 5 mm may require digitally subtracted angiography because of the low sensitivity of MR and CT angiography. In children, the choice of diagnostic test strategy depends on the risk group. In high-risk patients, MR imaging is the test of choice whereas in low-risk patients, close clinical observation with periodic reassessment is the best strategy [44]. Clinical diagnosis will always play a key role in the evaluation of headache disorders; however, for the small subset of patients who present with headache secondary to an intracranial space-occupying lesion, bleeding, or SAH, making the diagnosis is crucial to decreasing morbidity and mortality. CT, MR imaging, and lumbar puncture play important roles in the assessment of headache disorders, but their future roles will continue to evolve as the technology becomes more sophisticated and robust, and physicians become more expert with their use [1].

Adult↗
PubMed2001

Epidemiology of headache.

Headache disorders constitute a public-health problem of enormous proportions, with an impact on both the individual sufferer and society. Epidemiological knowledge is required to quantitate the significance of these disorders. The effects on individuals can be assessed by examining prevalence, distribution, attack frequency and duration, and headache-related disability. The socio-economic burden includes both direct costs associated with health care utilization and costs associated with missed work due to sickness absence or reduced efficiency. The individual and socio-economic burden of headaches is substantial. Headache disorders deserve more attention, especially concerning strategies leading to adequate primary prevention, diagnosis and treatment.

Headache↗
PubMed2004

Headaches and brain tumors.

A careful history and physical examination remain the most important aspects of headache assessment. enabling the neurologist to decide if any further studies are necessary. Only a minority of patients who have headaches have brain tumors; however, recognition of the headaches characteristically associated with tumors is most important. Some locations are more likely to produce headache (eg, a posterior fossa tumor causes headache more often than a supratentorial tumor). Rapidly growing tumors are more likely to be associated with headache. Uncommon headache presentations can occur with tumors, includin paroxysmal cough, cluster headache, and TACs. The classic brain tumor headache is not as common as a tension-type presentation or migraine. Patients who have prior primary headaches may have more headache symptoms if they have a tumor and of course they still have their primary headache disorder. Mass lesions progress and inevitably develop other symptoms and signs besides headache, and these new symptoms and signs must be sought and found. Metastatic leptomeningeal involvement can present with headache and spinal pain in the neck and back. Imaging of headache patients for tumors, if they have primary headache disorders, such as migraine and typical cluster, generally is not cost effective but is necessary if there are any atypical features. Treatment of headache in patients who have metastatic brain tumors should be aggressive in terms of pain and symptoms control. Treatment of primary CNS tumors is dictated by the kind of neoplasm and site, but control of headache should not be ignored.

Brain Neoplasms↗
PubMed1991

Short-term effect of occlusal adjustment on craniomandibular disorders including headaches.

The aim of this study was to assess the short-term effect of occlusal adjustment on craniomandibular disorders. Fifty patients were randomly selected and divided into a treatment (T) and a control (C) group. The initial clinical examination and the follow-up were made by one observer and the occlusal adjustment by another. There were no significant differences between groups with regard to frequency of headaches, facial pain, pain on mandibular function, or duration of headaches and facial pain. Fifty-two percent of the patients in the treatment group and 20% of the patients in the control group reported reduced subjective symptoms overall at follow-up examination. The improvement was statistically significant within the T group and significantly greater than in the C group. There was no significant change within or between groups with regard to frequency of headaches, facial pain, or pain on mandibular movements. There was an almost significant difference between groups after treatment with regard to changes in the number of tender muscles. The results of this study indicate that occlusal adjustment provides a general subjective improvement of craniomandibular disorders.

Adolescent↗
PubMed1999

Headaches and face pains as a manifestation of Munchausen syndrome.

Virtually every psychological or physical symptom may be feigned in order to assume a sick role; the term Munchausen syndrome is applied when the physical features are predominant. Complaints of headache as a manifestation of this condition are rare. We report such a case and review the literature of similar cases. A 34-year-old man consulted several headache specialists in different cities. Many different diagnoses were made, consistent with the various histories the patient related. It seems most unlikely that any one individual could experience 14 distinct headache disorders. Dozens of medications were prescribed, and a dozen or more were taken by the patient daily. People with Munchausen syndrome consciously feign physical symptoms and signs because of the apparently senseless need to assume a sick role. This condition is distinguished from malingering in which the symptoms are consciously feigned for personal gain and from somatoform disorder in which development of symptoms for psychological purposes is unconscious. Primary headache disorders, once thought to have a psychological basis, are now recognized as biological disorders. Though psychogenic mechanisms have been largely discredited, rarely, as illustrated by the present case, psychological mechanisms are predominant.

Adult↗
PubMed2003

Increased frequency of migraine in narcoleptic patients: a confirmatory study.

Previously we have reported an increased prevalence of migraine in narcoleptic patients. Because of the theoretical and clinical implications of this finding we recruited an independent new study sample of 100 patients with proven narcolepsy and conducted a structured 26-item interview based on the international diagnostic criteria for headache disorders, the Kiel Headache Questionnaire. Narcolepsy symptoms were measured by means of the Stanford Centre for Narcolepsy Sleep Inventory. Migraine prevalence was twofold to fourfold increased in the narcoleptic patients and amounted to 44.4% in women and 28.3% in men. The onset of narcolepsy symptoms was 12.3 +/- 11.4 years before the onset of migraine symptoms. The results might be regarded as indicative of a common pathophysiological pathway relevant to both of the two disorders.

Adult↗
PubMed1993

Headaches in the elderly.

Headache prevalence and etiology vary dramatically with age. The prevalence of primary headache disorders, such as migraine and cluster, declines with age, while the prevalence of secondary headache disorders, such as temporal arteritis and mass lesions, increases. In evaluating elderly patients with new onset of headache, a high index of suspicion for organic disease is required. Headache symptomatology also varies with age. For example, migraine may evolve into a pattern of chronic daily headache, or auras may occur in the absence of headache (late-life migraine accompaniments). A careful longitudinal headache history is therefore important. Headache management is also influenced by age. Elderly people are more susceptible to medication side effects and are often treated with several drugs. Medications may cause headaches and drug interactions may complicate therapy. For these reasons, age of onset and duration of illness are critical headache features that guide the subsequent approach to diagnosis and treatment.

Aged↗
PubMed1992

Interrelations between migraine and tension-type headache in the general population.

In a cross-sectional epidemiological survey of a general population, headache disorders were diagnosed according to a structured interview and a neurological examination using the criteria of the International Headache Society. The prevalences and sex distribution of the primary headache disorders were assessed, and characteristics of and interrelationships between different types of headache were analyzed. Severity and frequency of migraine attacks were not correlated, indicating that the migraine attack is an all-or-none phenomenon triggered with an individually variable threshold. Tension-type headache, in contrast, showed increasing severity with increasing frequency, indicating that it is a graded phenomenon. In the previous year, 6% had migraine without aura (previously called "common migraine") and 4% had migraine with aura (previously called "classic migraine"); 63% had episodic tension-type headache and 3% chronic tension-type headache. In women, migraine without aura was twice as prevalent as migraine with aura; in men, an opposite trend emerged. In migraine without aura, pain was more severe than in migraine with aura. Tension-type headache in migraineurs was not significantly more prevalent than in nonmigraineurs and, except for greater frequency and severity, it did not deviate nosographically from pure tension-type headache. Our results support the contention that migraine and tension-type headache are distinct entities, contradict the so-called continuum-severity model, and indicate that the terms combination headache, mixed headache, and interval headache should be avoided.

Adult↗
PubMed2002

Migraine: preventive treatment.

Migraine is a common episodic headache disorder. A comprehensive headache treatment plan includes acute attack treatment to relieve pain and impairment and long-term preventive therapy to reduce attack frequency, severity, and duration. Circumstances that might warrant preventive treatment include: (i) migraine that significantly interferes with the patient's daily routine despite acute treatment; (ii) failure, contraindication to, or troublesome side-effects from acute medications; (iii) overuse of acute medications; (iv) special circumstances, such as hemiplegic migraine; (v) very frequent headaches (more than two a week); or (vi) patient preference. Start the drug at a low dose. Give each treatment an adequate trial. Avoid interfering, overused, and contraindicated drugs. Re-evaluate therapy. Be sure that a woman of childbearing potential is aware of any potential risks. Involve patients in their care to maximize compliance. Consider co-morbidity. Choose a drug based on its proven efficacy, the patient's preferences and headache profile, the drug's side-effects, and the presence or absence of coexisting or co-morbid disease. Drugs that have documented high efficacy and mild to moderate adverse events (AEs) include beta-blockers, amitriptyline, and divalproex. Drugs that have lower documented efficacy and mild to moderate AEs include selective serotonin reuptake inhibitors (SSRIs), calcium channel antagonists, gabapentin, topiramate, riboflavin, and non-steroidal anti-inflammatory drugs.

Analgesics↗
PubMed2003

Hypnic headache: clinical features, pathophysiology, and treatment.

Hypnic headache has been described in several case reports since 1981 and is regarded as an idiopathic headache disorder. In this review of 71 cases in the literature, the clinical features, neurophysiologic including polysomnographic findings, and treatment procedures are analyzed and the pathophysiology of this condition, which remains however speculative, is discussed. There is some evidence that hypnic headache is related to REM sleep. The analysis shows that hypnic headache most probably is an entity among the idiopathic headache disorders unassociated with structural lesions and does not belong to the trigeminal-autonomic cephalalgias. Lithium shows the best efficacy; indomethacin, flunarizine, and caffeine may also be useful.

Adult↗
PubMedDate not supplied

Migraine: clinical features and diagnosis.

Migraine is a syndrome characterized by recurrent headaches with or without aura. Triggers include foods, hormonal changes, and stressors. Migraine must be differentiated from other unilateral headache disorders and from headaches due to other neurologic and systemic diseases.

Diagnosis, Differential↗
PubMed2007

Idiopathic intracranial hypertension.

Idiopathic intracranial hypertension is a secondary headache disorder characterized by headaches and visual symptoms. It most frequently occurs in obese women of childbearing age. However, many secondary causes exist, and it may affect children, men, and slim individuals. Prompt recognition, evaluation, and treatment are needed to prevent permanent visual loss.

Child↗
PubMedDate not supplied

Lithium orotate in the treatment of alcoholism and related conditions.

The subjects were 42 alcoholic patients (33 males and 9 females) who were treated with lithium orotate during an alcohol rehabilitation program in a private clinical setting for at least six months. They derive from a total number of 105 patients who received this treatment initially, while the remainder discontinued the treatment within six months. The data were collected from a private practice record and the follow-up varied between six months and 10 years. The 42 patients studied displayed a multitude of complaints in addition to chronic alcoholism. These included liver dysfunction, seizure disorders, headaches, hyperthyroidism, affective disorders. Meniere's syndrome, liver and lung cancers. Thirty-six of the 42 patients studied had been hospitalized at least once for the management of their alcoholism. Lithium orotate was given, 150 mg daily, with a diet low in simple carbohydrates and containing moderate amounts of protein and fat. In addition, calcium orotate (for hepatic involvement), magnesium orotate, bromelaine, and essential phospholipids (for cardiac problems), and supportive measures were instituted, if required. Lithium orotate proved useful as the main pharmacologic agent for the treatment of alcoholism. Ten of the patients had no relapse for over three and up to 10 years, 13 patients remained without relapse for 1 to 3 years, and the remaining 12 had relapses between 6 to 12 months. Lithium orotate therapy was safe and the adverse side effects noted were minor, i.e., eight patients developed muscle weakness, loss of appetite or mild apathy. For these patients, the symptoms subsided when the daily dose was given 4 to 5 times weekly.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcoholism↗
PubMed2004

Headaches in pregnancy.

Migraine and TTH are primary headache disorders that occur commonly during pregnancy. Migraine sometimes occurs for the first time with pregnancy. The majority of migraineurs improve while pregnant; however, migraine often recurs post partum. Some disorders that produce, headache, such as stroke, cerebral venous thrombosis, eclampsia, and SAH, occur more frequently during pregnancy. Diagnostic testing serves to exclude organic causes of headache, to confirm the diagnosis, and to establish a baseline before treatment. If neurodiagnostic testing is indicated, the study that provides the most information with the least fetal risk is the study of choice. Drugs commonly are used during pregnancy despite insufficient knowledge about their effects on the growing fetus. Most drugs are not teratogenic. Adverse effects, such as spontaneous abortion, developmental defects, and various postnatal effects, depend on the dosage and route of administration and the timing of the exposure relative to the period of fetal development. Although medication use should be limited, it is not absolutely contraindicated in pregnancy. In migraine, the risk for status migrainosus may be greater than the potential risk of the medication used to treat the pregnant patient. Nonpharmacologic treatment is the ideal solution; however, analgesics, such as acetaminophen and narcotics, can be used ona limited basis. Preventive therapy is a last resort.

Adult↗